021 POST TRANSPLANT DIABETES MELLITUS (PTDM) – ANALYSIS OF RISK FACTORS, EFFECTS ON BIOCHEMICAL PARAMETERS AND GRAFT FUNCTION – AT THE END OF 5 YEARS AFTER RENAL TRANSPLANTATION

Abstract Introduction Genetic mutations such as C599T polymorphism in glutathione peroxidase [GPX1] gene and polymorphisms in potassium channel (KCNJ11) genes have recently been proposed in the etiopathogenesis of new onset diabetes mellitus after renal transplantation (NODAT). We aimed to examine the association of GPX1 and KCNJ11 polymorphisms in NODAT. Materials and Methods This is a monocenter case-control study with a total of 118 renal transplant recipients who were divided into 2 groups; NODAT and normal glucose tolerance. Relation of GPX1 and KCNJ11 polymorphisms were investigated between these groups. PCR-RFLP method was used for genotyping of polymorphisms in the GPX1 (rs1050450) and KCNJ11 (rs1805127) genes. Two alleles were visualized for each gene (C/T for GPX1 and A/G for KCNJ11). Results NODAT was correlated with age at transplantation (p<0.001, r=0.380), post-transplant systolic blood pressure (BP) (p=0.02, r=0.211), post-transplant non-HDL cholesterol levels (p=0.01, r=0.803), degree of weight change at the end of the first year (p=0.01, r=0.471), presence of pre-transplant hypertension (HT) (p=0.02, r=0.201), family history of diabetes (p=0.01, r=0.29) and dyslipidemia (p=0.012, r=0.362). GPX1 polymorphism of TT (mutant) allele was significantly more frequent in patients with NODAT (p<0.001, r=0.396) independent from other diabetogenic risk factors. KCNJ11 polymorphisms were similar in both groups and did not show any significant association with NODAT (p=0.10). Conclusions In addition to several diabetogenic risk factors, C599T polymorphisms in GPX1 gene might also contribute to the development of NODAT. Further studies on larger patient series are necessary in order to reach definitive suggestions.

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Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

Clinical Kidney Journal ◽

10.1093/ckj/sfaa061 ◽

2020 ◽

Author(s):

Julio Chevarria ◽

Donal J Sexton ◽

Susan L Murray ◽

Chaudhry E Adeel ◽

Patrick O’Kelly ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Graft Failure ◽

Graft Function ◽

Renal Transplant Recipients ◽

Post Transplant ◽

All Cause Mortality ◽

Transplant Function ◽

The Republic ◽

The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

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Post Transplant Diabetes Mellitus after Renal Transplantation: The Emerging Clinical Challenge

Yonsei Medical Journal ◽

10.3349/ymj.2004.45.6.1059 ◽

2004 ◽

Vol 45 (6) ◽

pp. 1059 ◽

Cited By ~ 9

Author(s):

Vinod Ravindran ◽

Keshwar Baboolal ◽

Richard Moore

Keyword(s):

Diabetes Mellitus ◽

Renal Transplantation ◽

Post Transplant ◽

Clinical Challenge

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Diagnosis of a plasmoblastic lymphoma of the mandible after renal transplantation: a case report

Journal of Oral Medicine and Oral Surgery ◽

10.1051/mbcb/2021036 ◽

2021 ◽

Vol 27 (4) ◽

pp. 46

Author(s):

Inès Legeard ◽

Marc-Antoine Chevrollier ◽

Gérard Bader

Keyword(s):

Risk Factors ◽

Case Report ◽

Renal Transplantation ◽

Epstein Barr Virus ◽

Solid Organ ◽

Post Transplant ◽

Barr Virus ◽

Non Hodgkin Lymphoma ◽

Epstein Barr

Introduction: Post-transplant lymphoproliferations (PTL) are a severe complication of solid organ transplants. Their locations can be extra-nodal. Observation: The diagnosis and management of a non-Hodgkin's plasmablastic lymphoma of mandibular localization affecting a 66-year-old kidney transplanted patient are reported here. Comment: The main risk factors for non-Hodgkin lymphoma are immunosuppression and infection with Epstein-Barr virus. Clinical and radiographic examinations, which are not specific, must be supplemented by a histological examination. Treatment which is not consensual will most often consist of a reduction in immunosuppression coupled with chemotherapy. Conclusion: Despite a constant evolution in the incidence and clinical picture of post-transplant lymphomas, the role of the dentist remains essential in the early detection of lesions.

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Explained and Unexplained Ischemic Heart Disease Risk after Renal Transplantation

Journal of the American Society of Nephrology ◽

10.1681/asn.v1191735 ◽

2000 ◽

Vol 11 (9) ◽

pp. 1735-1743 ◽

Cited By ~ 2

Author(s):

BERTRAM L. KASISKE ◽

HARINI A. CHAKKERA ◽

JOSEPH ROEL

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Transplantation ◽

Relative Risk ◽

Renal Transplant ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Calcium Channel Antagonists ◽

Relative Risks ◽

Cholesterol Levels

Abstract. Whether the high incidence of ischemic heart disease (IHD) among renal transplant patients can be attributed to the same risk factors that have been identified in the general population is unclear. The risk for major IHD events occurring >1 yr after transplantation among 1124 transplant recipients was estimated by using the risk calculated from the Framingham Heart Study (FHS). The FHS risk predicted IHD (relative risk, 1.28; 95% confidence interval, 1.20 to 1.40; P < 0.001); however, the FHS risk tended to underestimate the risk of IHD for renal transplant recipients. This was largely attributable to increased risks associated with diabetes mellitus and, to a lesser extent, age and cigarette smoking for renal transplant recipients. For men, the relative risks for diabetes mellitus were 2.78 (1.73 to 4.49) and 1.53 for the transplant recipient and FHS populations, respectively; the relative risks for age (in years) were 1.06 (1.04 to 1.08) and 1.05, respectively, and those for smoking were 1.95 (1.20 to 3.19) and 1.69, respectively. For women, the relative risks for diabetes mellitus were 5.40 (2.73 to 10.66) and 1.82, respectively. There was a tendency for the risk associated with cholesterol levels to be higher for transplant recipients, compared with the FHS population, but the risks associated with high-density lipoprotein cholesterol levels and BP appeared to be comparable. Independent of these and other risk factors, the adjusted risk of IHD for the transplant recipient population has decreased. Compared with the era before 1986, transplantation between 1986 and 1992 was associated with a lower relative risk of 0.60 (0.39 to 0.92); transplantation after 1992 was associated with an even lower relative risk of 0.27 (0.11 to 0.63) for IHD. Of concern was the fact that dihydropyridine calcium channel antagonists were associated with an increased risk for IHD (relative risk, 2.26; 95% confidence interval, 1.24 to 4.12; P = 0.008), and this association was independent of other antihypertensive agents and risk factors. Therefore, although the FHS risk predicts IHD after renal transplantation, it tends to underestimate the risks, especially the risk associated with diabetes mellitus. The unexpected finding that dihydropyridine calcium channel antagonists were associated with an increased IHD risk merits further evaluation.

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Post-transplant diabetes mellitus in children following renal transplantation

Pediatric Transplantation ◽

10.1111/j.1399-3046.2007.00862.x ◽

2008 ◽

Vol 12 (6) ◽

pp. 643-649 ◽

Cited By ~ 33

Author(s):

A. Prokai ◽

A. Fekete ◽

E. Kis ◽

G. S. Reusz ◽

P. Sallay ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Transplantation ◽

Post Transplant

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2659. Retrospective Review of Biopsy Proven Acute Graft Pyelonephritis in Renal Transplant Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2337 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S930-S930

Author(s):

Harry Ross Powers ◽

Walter Hellinger ◽

Cherise Cortese ◽

Hani M Wadei

Keyword(s):

Risk Factors ◽

Acute Rejection ◽

Serum Creatinine ◽

Potential Risk ◽

Medical Center ◽

Graft Function ◽

Post Transplant ◽

Histologic Evidence ◽

Potential Risk Factors ◽

Acute Graft

Abstract Background There are few studies of histologic acute graft pyelonephritis (HAGPN) following kidney transplant (KT). The goals of this study are to determine incidence, identify potential risk factors and describe outcomes of HAGPN in a large cohort of KT recipients. Methods Renal allograft biopsies of all patients undergoing first KT at our medical center between 2008 and 2017 were reviewed. HAGPN was defined as the presence of neutrophils within the interstitium and tubules (casts). Medical charts of patients with HAGPN were reviewed. Episodes of bacteriuria (≥10:5 cfu/mL growth in culture) were classified as urinary tract infection (UTI) or asymptomatic bacteruria (ASB) based upon documented symptoms. An episode of acute rejection was defined as pulse parenteral immunosuppressive therapy for histologic evidence of rejection. Results HAGPN was identified in 43 of 1,391 (3.1%) KT recipients at a median of 298 days post-transplant. There were no significant differences between recipient age or gender, donor age or transplant type (deceased, living related, living unrelated) between recipients with and without HAGPN. Urologic malformation was diagnosed in 14 (33%) by day 30 post-transplant. Twenty-five (58%), 17 (40%), and 13 (30%) sustained one or more episodes of acute rejection, UTI and ASB, respectively, prior to HAGPN. At diagnosis of HAGPN, 28 (65%), 7 (16%), and 16 (37%) had histologic evidence of rejection, UTI and ASB, respectively. Twenty-two (51%) and 37 (86%) were treated with pulse immunosuppression and antibiotics, respectively. Median nadir serum creatinine before HAGPN was 1.1 mg/day while median serum creatinine at 6 and 12 months after HAGPN were 1.5 and 1.6. Three patients (7%) developed graft failure within 1 year after HAGPN. Conclusion HAGPN is an infrequent complication of KT. A majority of patients with HAGPN have histologic evidence of rejection and either UTI or ASB at diagnosis, though over 40% have neither UTI nor ASB. When rejection accompanying HAGPN is routinely treated with pulse immunosuppression and antibiotic therapy is administered, graft function is preserved for most patients but a minority (7%) loses graft function within 1 year. Potential risk factors to be assessed in further study include post-transplant urologic dysfunction, acute rejection and UTI. Disclosures All authors: No reported disclosures.

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Impact of pretransplant mitral annular calcification on the incidence of cardiac events after renal transplantation

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz063 ◽

2019 ◽

Vol 35 (3) ◽

pp. 526-533 ◽

Cited By ~ 1

Author(s):

Nadia El Hangouche ◽

Javier Gomez ◽

Addis Asfaw ◽

Jayakumar Sreenivasan ◽

Tauseef Akhtar ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplantation ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Cardiac Events ◽

Mitral Annular Calcification ◽

Post Transplant ◽

Increased Risk ◽

Annular Calcification

Abstract Background Mitral annular calcification (MAC) is associated with increased risk of major adverse cardiac events. We hypothesized that MAC, identified on a pretransplant transthoracic echocardiography (TTE), is predictive of cardiac events following renal transplantation (RT). Methods In a retrospective cohort of consecutive RT recipients, pretransplant MAC presence and severity were determined on TTE performed within 1 year prior to transplant. MAC severity was quantified based on the circumferential MAC extension relative to the mitral valve annulus. Post-transplant cardiac risk was assessed using the sum of risk factors (range: 0–8) set forth by the American Heart Association/American College of Cardiology Foundation consensus statement on the assessment of RT candidates. Subjects underwent pretransplant stress single-photon emission computed tomography myocardial perfusion imaging and followed for post-transplant composite outcome of cardiac death or myocardial infarction (CD/MI). Results Among 336 subjects (60.5% men; mean age 52 ± 12 years), MAC was present in 78 (23%) patients. During a mean follow-up of 3.1 ± 1.9 years, a total of 70 events were observed. Patients with MAC had a higher event rate compared with those without MAC (34.6% versus 17.8%, log-rank P = 0.001). There was a stepwise increase in CD/MI risk with increasing MAC severity (P for trend = 0.002). MAC-associated risk remained significant after adjusting for sex, duration of dialysis, sum of risk factors, ejection fraction and perfusion abnormality burden, providing an incremental prognostic value to these parameters (Δχ2 =4.63; P = 0.031). Conclusion Among RT recipients, the burden of pretransplant MAC is an independent predictor of post-transplant risk of CD/MI. MAC should be considered in the preoperative assessment of RT candidates.

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